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Just another WordPress siteTue, 19 Jun 2018 05:33:55 +0000en-UShourly1https://wordpress.org/?v=4.9.8PTSD: THE BRAIN AND PSYCHE REWIREDhttp://www.reshealth.net/articles/ptsd-the-brain-and-psyche-rewired/
http://www.reshealth.net/articles/ptsd-the-brain-and-psyche-rewired/#respondMon, 18 Jun 2018 22:16:58 +0000http://www.reshealth.net/?p=504Post-traumatic stress disorder is generally perceived as a mental disorder that occurs in combat veterans who experience the trauma of war. The truth is that PTSD can occur in any adult or child exposed to any traumatic event such as a natural disaster, serious traffic accident or the violence of rape or other physical assault. […]]]>

Post-traumatic stress disorder is generally perceived as a mental disorder that occurs in combat veterans who experience the trauma of war. The truth is that PTSD can occur in any adult or child exposed to any traumatic event such as a natural disaster, serious traffic accident or the violence of rape or other physical assault. A person need not be the actual victim of the traumatizing event; simply witnessing one can lead to the development of PTSD. Not surprisingly, veterans, rescue workers and emergency medical personnel–individuals whose work commonly entails exposure to disturbing events–are particularly susceptible to developing PTSD, as are children exposed to sexual abuse or domestic violence.

Fight or Flight

It is natural to feel afraid during a stressful situation—fear triggers instant changes in the brain that help humans defend against danger (fight) or avoid it (flight). The “fight or flight” response exists in virtually all living things to guard against injury or being killed. Stress reactions such as a pounding heartbeat, anxiety and panic help humans and other animals react to danger quickly to save themselves or confront the threat at hand. Once the emergency has ended, most people feel relief and, often, some lingering anxiety and fear that gradually fade away. But in patients with PTSD heightened stress responses linger and intensify, causing uncontrollable and emotionally crippling symptoms for many months or even years after the trauma occurs.

As mentioned, it is normal for a person exposed to traumatic events to have some lingering symptoms for a time, or even develop short-term acute stress disorder. In these cases, the symptoms will lessen and eventually resolve in a matter of weeks or months. A diagnosis of PTSD entails more enduring symptoms, including:

Re-experiencing: Reliving the trauma repeatedly in flashbacks, physical symptoms such as a racing heart and sweating, nightmares, and frightening thoughts and feelings. These re-experiencing symptoms can disrupt a patient’s daily routines and ability to function. Seemingly random words, objects or situations can trigger a re-experiencing event.

Avoidance: Patients with PTSD may show avoidance behaviors, such as keeping their distance from objects, experiences and places that remind them of the triggering event (for example, refusing to ride in/drive a car after exposure to a traffic accident). They might also avoid feelings or thoughts related to the event (for example, being unwilling to watch a movie featuring cars or driving).

Arousal and Reactivity: These symptoms in patients with PTSD involve being easily startled, feelings of being tense and edgy, difficulty sleeping and angry outbursts. The behavior is generally consistent rather than being triggered by a reminder of the traumatic episode. Arousal and reactivity symptoms interrupt daily activities such as sleeping, concentrating on routine tasks, and eating.

Cognition and Mood: Cognitive and mood symptoms typically include difficulty remembering the traumatic event, feelings of guilt or blame, loss of interest in activities that were previously enjoyable, and negative feelings about the world and oneself.

Patients may manifest all or most of the above symptoms, or just a few from each category. Regardless, the National Institute of Mental Health’s guidelines indicate that a diagnosis of PTSD requires, at minimum, the recurrent presence of 1 re-experiencing symptom, 1 avoidance symptom, 2 arousal symptoms and 2 cognition/mood symptoms.

PTSD: Psychology or Physiology?

Initially, PTSD was conceived as a purely psychological response to trauma. The American Psychiatric Association added PTSD to the DSMV III in 1980 in the wake of clinical studies and reports in the 70s on a cluster of symptoms specific to Vietnam combat troops. But the concept was not a new one; in 1915, the term “shell shock” was coined to describe similar symptoms in World War I servicemen, especially those who were subjected to repeated bombardment from enemy fire. But with advances in neurology and brain imaging, researchers have shown that brain function is altered in people with PTSD, within three main areas of the brain:

1.. The amygdala is an area of the brain key in regulating emotions, especially fear.

2.. The ventromedial prefrontal cortex (vmPFC) area controls higher functions, such as emotional processing and decision-making.

3.. The hippocampus, the largest area of the three discussed herein, is involved in memory—especially spatial memory of places.

In people with a normal response to dangerous cues from their environment–for example, seeing a shark in a tank at the aquarium–the amygdala becomes active, sending fight or flight messages to other areas of the brain. At that moment, the “higher thinking” vmPFC communicates to the amygdala that the shark is contained, no need to worry. The hippocampus supports the amygdala by providing context such as “you recognize this setting; you are at the aquarium.” These processes allow the vmPFC to inhibit the fearful impulses of the amygdala.

Conversely, in people with PTSD, brain imaging studies show that the vmPFC is underactive, which allows the unfettered amygdala to produce the uncontrollable and intense panic and anxiety so common in the disorder. The exact reason for this brain imbalance is not known. Research has shown, however, that extremely stressful events (war, witnessing terrible events, sexual assault) results in acute and chronic changes in neurochemical systems such as the stress response brain chemicals cortisol and norepinephrine. Changes in specific brain regions and chemistry result in alterations in the workings of brain circuits involved in reasoning, stress responses and memory.

Treatment Approaches

The first task is to ascertain that your patient is indeed suffering from PTSD and not a different mental disorder (for information on PTDS and differential diagnosis, visit https://bit.ly/2J8jBwx). Screen for dual-diagnoses; many patients with PTSD will have a co-occurring condition such as substance use, depression and/or suicidal ideation (for a comprehensive list of diagnostic tools, visit https://bit.ly/2sjHR4D).

As is true of all behavioral health treatments, there is no single one-size-fits all approach to treating PTSD. Research shows, however, that the best evidence-based treatments for PTSD include psychotherapy, medications, or a combination of both, specifically:

Cognitive behavioral therapy, which can help to identify the events, situations and objects that trigger symptoms, and how to address these triggers. In addition, CBT can help educate patients about trauma and its effects; provide relaxation and anger-control skills; tips on improving diet, sleep and exercise habits; address feelings of guilt, shame and blame surrounding the traumatic event; and change reactions to PTSD symptoms.

CBT therapies may include exposure therapy/prolonged exposure therapy to help patients control the symptoms caused by fear. Employing mental imagery, writing exercises and revisiting the place where the trauma occurred can all help patients to overcome or tolerate distressing emotions and reminders.

Cognitive processing therapy can help patients gain control over disturbing thoughts and learn how their traumatic experience changed them and their world view. Doing so enables them to gain insight into their emotions and behavior.

The use of eye movement desensitization and reprocessing therapy (EMDR) makes use of rapid and rhythmic eye movements to stimulate the brain while revisiting the traumatic event. EMDR can unlock negative emotions to help patients develop coping mechanisms.

For children and adolescents, trauma-focused CBT (TF-CBT) is an effective approach for young people exposed to a wide-array of traumas, including war, domestic violence, traumatic loss and the complexities of surviving foster care. However, this type of therapy should only be provided by a TF-CBT certified therapist. For more on this approach, visit https://bit.ly/2xcP3F7.

A wide array of medications for patients with PTSD have been proven effective. Certain drugs can help them manage problems with addiction, sleep disturbances, depression, anger, anxiety, despair and loss of control. The National Institute of Mental Health’s comprehensive list of medications can be found at https://bit.ly/2lv5cLV.

Complimentary therapies often help patients with PTSD to recover, including family therapy, mindfulness training, meditation and yoga, companion dog and horse therapy, and self-expression through art or writing assist patients to find positive outlets for their emotions. Connecting with new and old friends, socializing with others who have experienced a similar trauma and volunteering create support networks and reconnection to their communities.

PTSD is a multi-faceted and debilitating condition that wreaks havoc on the psyche and the brain’s circuitry. With compassionate and evidence-based care provided by an experienced professional, however, people can and do recover every day.

]]>http://www.reshealth.net/articles/ptsd-the-brain-and-psyche-rewired/feed/0Brain Wellness (Part 2) – WHAT HAPPENS TO A MISTREATED BRAIN?http://www.reshealth.net/articles/brain-wellness-part-2-what-happens-to-a-mistreated-brain/
http://www.reshealth.net/articles/brain-wellness-part-2-what-happens-to-a-mistreated-brain/#respondMon, 18 Jun 2018 22:15:33 +0000http://www.reshealth.net/?p=522In the first part of this brain wellness series, we reviewed brain structure and function, including the key elements required to maintain brain wellness. These elements include adequate sleep, nutrition, exercise, positive social interaction, exposure to sunlight and avoidance of toxins‒all aspects of a healthy lifestyle. But what happens when the brain is deprived of […]]]>

In the first part of this brain wellness series, we reviewed brain structure and function, including the key elements required to maintain brain wellness. These elements include adequate sleep, nutrition, exercise, positive social interaction, exposure to sunlight and avoidance of toxins‒all aspects of a healthy lifestyle.

But what happens when the brain is deprived of these key elements or is exposed to toxic elements on a regular basis? Our second installment of the series this month is dedicated to the pathophysiology of the mistreated brain, and how to diagnose and treat common clinical manifestations caused by unbalanced or unhealthy lifestyles.

Pathophysiology of Mental Illness

Mental illness is extremely common in the United States; nearly 50 percent of all Americans experience a mental disorder at least once in their lifetime. Risk factors include a family history of mental issues and adverse conditions, including environmental toxins, socioeconomic adversities, trauma, other illnesses and abuse. Drug and alcohol use can be a risk factor for, or a symptom of, mental illness. For a detailed discussion on risk and protective factors, visit https://bit.ly/2HOYL0w.

The pathophysiology of mental illness involves derangements in the complex neurobiological structures and networks discussed in Part 1 of this series. This process involves malfunctions in brain tissue, electrochemical signaling and silencing along with neural circuit functioning. Recent advances in cognitive neuroscience, brain imaging and epigenetics (turning genes on and off) are changing the way researchers approach the diagnosis and management of mental illnesses. But these disorders can manifest on every level, from molecules to consciousness. So, despite our complex and detailed knowledge of neurobiology, we cannot directly translate this information into concrete clinical psychiatric practices. Consciousness is too subjective, and the nature of human experience is too broad.

When mental illness does manifest, there are specific emotional symptoms, behavioral indicators and physical signs of lifestyle imbalance that steer the skilled clinician to the correct diagnosis(es). Symptom severity can be quantified using measurement-based care (MBC) to aid in assessment, modifying treatment and measuring outcomes. The standardized questionnaires used to this end are based on diagnostic criteria found in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. (We’ll discuss MBC in more detail later in this series.)

Clinical Manifestations of Mental Illnesses

The most common clinical manifestations of the mistreated brain are anxiety and depression. The key moderating factors that determine whether mental illness will reach a clinical threshold are stress (perceptions of severity) and coping (behavioral responses). For example, a person with a balanced lifestyle who gets laid off may experience moderate stress, but copes by increasing exercise and positive social interactions while maintaining other key elements of brain wellness. Another person in the same situation, however, may cope by isolating herself, staying up all night worrying, or turning to drugs or alcohol for relief. This individual is far more likely to develop mental illnesses and/or other problems linked to substance use. (See the following illustration of where the stress response occurs in the brain).

The Profound Effect of Lifestyle on the Brain

The way individuals cope with stress is directly related to their lifestyle habits. Habits and coping strategies largely determine whether a person will be resilient to or vulnerable to stress. Maladaptive stress responses, such as drinking too much or avoiding friends, increase anxiety and depression, which in turn may trigger maladaptive behavior. The result is a vicious cycle that increases the risk of behavioral health disorders, as shown in the flowchart below:

After depression and anxiety, the most common forms of mental illness are trauma-related disorders, obsessive-compulsive disorders, phobias, bipolar illness, personality disorders and psychosis. Behavioral disorders, such as eating disorders and addiction, go hand-in-hand with mental disorders and can occur as a direct result of behavioral problems or because of them (such as self-medicating with drugs and alcohol). However, maladaptive behaviors are not set in stone and can be prevented, managed or even cured by attending to the brain’s needs daily, allowing it to function properly.

Adequate Sleep

Getting sufficient sleep is essential for brain wellness. Each phase of sleep serves a function for information processing, rest and healing. Chronic sleep deprivation has detrimental effects on the brain and other organs (see the figure below).

Common causes of insomnia and sleep deprivation include poor “sleep hygiene,” anxiety, substance use, environment and mental illness. Good sleep hygiene consists of healthy habits that are conducive to quality sleep and regular sleep times. For example, avoiding caffeine and electronic devices prior to getting into a clean, comfortable bed before turning out the light is good sleep hygiene. Avoiding long-term use of sleep medication is essential because such medications disrupt sleep quality by preventing normal phases of sleep. Also, even over-the-counter sleep medication can be habit-forming and lead to memory loss and dementia.

Nutrition

Unfortunately, the typical American diet consists largely of foods from boxes, cans, jars and packages, all of which contain many mysterious ingredients that are difficult to pronounce. Many Americans substitute fast foods for home-cooked meals, washing them down with bubbly chemical beverages. While this is unhealthy for anyone, it is particularly dangerous for people with mental health and substance use issues.

Focusing diet on consuming essential nutrients, on the other hand, helps to restore neurotransmitters in the brain, which improves mood and cognitive function. But what is a healthy diet? Nutrition experts at Yale University compared common types of diets – such as low fat, low carbohydrate, etc. – to see which ones were the healthiest. While no single diet was superior, the researchers stated, “…a diet of minimally processed foods close to nature, predominantly plants, is decisively associated with health promotion and disease prevention.”

For individuals recovering from addiction, a healthy diet can also help to maintain sobriety by reducing or eliminating cravings for drugs and alcohol. Avoiding sugary foods and beverages prevents stimulation of addiction receptors in the brain. In addition to consuming a nutritious diet, people in recovery benefit from avoiding a few dietary no-no’s:

. Avoid or minimize caffeine intake, as it mimics the effects of neurotransmitters

. Avoid fasting, as hunger can trigger cravings

. Eliminate refined sugar, as it also stimulates addiction receptors

. Minimize intake of simple carbohydrates such as white bread, pasta, white rice and bakery products; the body converts these foods into sugar, a stimulator of addiction receptors

Remember, patients should consult with a health care provider before starting a new diet, including taking nutritional supplements such as vitamins and mineral products.

Exercise

The importance of exercise for brain wellness cannot be understated. Daily exercise is a well-established treatment for patients with depression, anxiety, psychosis and mood disorders, and those who are recovering from addiction. A review of the literature suggests exercise also decreases craving and drinking in patients with substance use disorders. Exercise increases oxygen delivery to the brain, liver and heart, which promotes healing and prevents disease. Endorphins released during exercise improve mood and decrease anxiety.

Outdoor exercise is optimal to prevent vitamin D and magnesium deficiency; both nutrients are required for normal brain function. But how much exercise is needed to achieve these effects? See the infographic on page 17 for basic recommendations on a healthy exercise routine.

Positive Social Interaction

Humans cannot thrive in isolation. There is overwhelming evidence that positive supportive social groups are essential for normal growth and development, and contribute to longevity. Socializing helps people process stress and buffer adversity. Add a dash of laughter as it has been shown to improve cognitive function and overall feelings of well-being. Maybe it really is the best medicine.

The importance of having a social life and support groups for people recovering from addiction was illustrated in a 1999 study published in The American Journal of Drug and Alcohol Abuse. The research examined qualities of support groups whose members had the lowest relapse rates over two years. The most successful group members had formed friendships that extended beyond the group and participated in group special events and activities such as outreach, volunteering and fundraising.

Toxins

While avoiding toxins may sound simple, it is not; they are everywhere, in our air, water and food. There is evidence that invisible radiation from the environment, including electromagnetic radiation from Wi-Fi and electronics, can be harmful. Many of these elements are an unavoidable part of daily life, but patients can be counseled to avoid chemical exposure from smoking, vaping, taking drugs and drinking alcohol. Mind-altering drugs damage the brain and nervous system and permanently affect neural networks. Fortunately, these effects can be overcome with abstinence and evidence-based treatment.

Conclusion

Fortunately, the human brain is just as simple as it is complex. The master organ needs an adequate amount of a few simple things daily to function properly. When the brain is mistreated, it becomes ill. The first line of treatment, therefore, is to restore homoeostasis by increasing the healthy lifestyle habits the brain needs. Doing so not only improves mental health and overall well-being, but it prevents physical illnesses as well. Even under the best circumstance, however, mental illnesses and addiction can develop that require professional treatment. Reminding patients that caring for their bodies will help their brains can improve outcomes and even accelerate recovery.

“We are what we repeatedly do. Excellence is not an act, but a habit.”

—Will Durant (U.S. American writer, historian and philosopher)

About the Author

Dana Connolly, Ph.D., is a senior staff writer for Sovereign Health. She earned her Ph.D. in research and theory development from New York University and has decades of experience in clinical care, medical research and health education. For more information, inquiries or to comment on this article, contact the author at news@sovhealth.com.

]]>http://www.reshealth.net/articles/brain-wellness-part-2-what-happens-to-a-mistreated-brain/feed/0Aetna Practices Latest Example of Unethical Health Industry Wayshttp://www.reshealth.net/articles/aetna-practices-latest-example-of-unethical-health-industry-ways/
http://www.reshealth.net/articles/aetna-practices-latest-example-of-unethical-health-industry-ways/#respondMon, 18 Jun 2018 22:10:50 +0000http://www.reshealth.net/?p=519There’s something rotten in Denmark. Maybe it’s wafting over from the U.S. health insurance industry. CNN reports that a former Aetna medical director admitted, under oath, that he never looked at patient records prior to approving or denying care, relying instead on the recommendations from nurses at the insurance giant. The admission from physician Dr. […]]]>

There’s something rotten in Denmark. Maybe it’s wafting over from the U.S. health insurance industry. CNN reports that a former Aetna medical director admitted, under oath, that he never looked at patient records prior to approving or denying care, relying instead on the recommendations from nurses at the insurance giant.

The admission from physician Dr. Jay Ken Iinuma emerged in his deposition in response to a lawsuit from patient Gillen Washington, who sued Aetna for breach of contract and bad faith after the insurer refused to pay for his expensive infusions for a rare medical condition. Mr. Washington alleges that the “reckless withholding of benefits almost killed him,” CNN reports.

The network brought the case to the attention of California Insurance Commissioner Dave Jones, who commented, “If the health insurer is making decisions to deny coverage without a physician actually ever reviewing medical records, that’s of significant concern to me as insurance commissioner in California—and potentially a violation of law.” The commissioner opened an investigation into Aetna’s practices after CNN brought the case to his attention.

In the same report, CNN states that Aetna defended Dr. Iinuma, saying in its legal brief that he relied on his “years of experience” as a trained physician in making his decision about Washington’s treatment, and that the doctor followed Aetna’s Clinical Policy Bulletin appropriately.

Aetna also alleged that Mr. Washington had missed appointments for bloodwork related to his condition.

But that doesn’t explain why Aetna’s medical director was not reviewing patient cases before denying coverage. According to CNN, Iinuma, who signed Mr. Washington’s pre-authorization denial, said during his videotaped deposition that he never read Washington’s medical records and knew next to nothing about his disorder.

Unfortunately, refusing to pay for insured patients’ treatment is not unusual in California and elsewhere. A case is pending against Health Net (currently a subsidiary of Centene Corp.) for unlawfully refusing to pay millions of dollars in claims to treatment centers in Arizona and California, according to the website of law firm Gallagher & Kennedy.

According to the California complaint, Health Net “…began categorically denying substance abuse claims submitted by California treatment centers. The claim denials were done via form letters signed by Matthew Wong, M.D.” The complaint also asserts, “The claim denials based upon lack of medical necessity contained no distinction based upon the type of substance abuse or any other key details surrounding treatment.” And a Health Net clerk, Matthew Ciganek, was “robo-signing medical necessity denials, regardless of the underlying treatment details,” the complaint alleges.

Inadequate Health Networks

Centene/Health Net is no stranger to accusations of bilking both providers and subscribers alike. In January 2018, the company made the news when a lawsuit filed in Washington state alleged that customers in 15 states who purchased Centene insurance via the Affordable Care Act exchanges could not find in-network doctors and hospitals. According to the lawsuit, “Centene misrepresents the number, location and existence of purported providers by listing physicians, medical groups and other providers—some of whom have specifically asked to be removed—as participants in their networks and by listing nurses and other non-physicians as primary care providers.”

Former Congresswoman Donna Christensen, in a recent opinion piece in the Washington Examiner on “narrow” networks, commented that as Centene/Health Net has expanded into markets that other insurance companies have abandoned, “the company is taking advantage of vulnerable Americans, falsely touting an adequate provider network when the actual plans are so skimpy that many critics question whether they even meet minimum coverage requirements.” She added, “This practice completely violates consumers’ rights.” Ms. Christensen currently serves on the board of Consumers for Quality Care.

Death by Bureaucracy

In another California lawsuit filed against Health Net in 2017, the family of a woman who died awaiting a liver transplant alleged that she was the victim of Health Net’s disregard for her ailing health, according to a report in the Daily Breeze. When Health Net had no in-network provider qualified to perform the transplant, the insurer dithered for months, allegedly searching for an out-of-network liver transplant specialist. The woman died before she even had a transplant consultation.

According to the news report, her family’s attorney, Travis Corby commented, “No person in this country should be forced to wait months just to receive an initial consultation for life-saving treatment. [She] died without even having a chance at receiving the care she deserved.” Mr. Corby added, “HMOs like Health Net…should not be permitted to make patients wait in perilous condition while it spends months ‘negotiating’ a contract and looking to save itself money on care that should be immediately available to its insureds,” Corby added. “It is death by bureaucracy.”

The great irony is that Centene has been making billions of dollars in profits off Obamacare and other plans (the company posted a whopping $239 million profit in the third quarter of 2017 alone, up 22 percent from the same period the previous year). The company’s stock has been a hot commodity in recent months. Their CEO, Michael Neidorff, is the highest paid executive in the industry, raking in nearly $22 million in 2016, $411,800 of which was received as stock options and $12,829,500 as stock, according to salary.com.

The rich get richer while the insured get sicker. Is this the health care America deserves? When even having insurance means there is no available networks, claims are denied, procedures delayed…and patients die? It is time to hold insurers accountable. Healthy Americans are money in the bank.

]]>http://www.reshealth.net/articles/aetna-practices-latest-example-of-unethical-health-industry-ways/feed/0Notes from ATA18: TELEHEALTH AIMS TO BRING PSYCHIATRIC SERVICES HOMEhttp://www.reshealth.net/articles/notes-from-ata18-telehealth-aims-to-bring-psychiatric-services-home/
http://www.reshealth.net/articles/notes-from-ata18-telehealth-aims-to-bring-psychiatric-services-home/#respondMon, 18 Jun 2018 22:09:14 +0000http://www.reshealth.net/?p=525Get ready for a world where psychiatric services can be provided right at home. Instead of choosing a pay-per-view movie to lift their spirits, patients may soon be able to sit in a beloved armchair–slippers on and kitty in the lap–and receive a therapy session. In a session titled “Increasing the Reach of Evidence-Based Psychotherapy […]]]>

Get ready for a world where psychiatric services can be provided right at home. Instead of choosing a pay-per-view movie to lift their spirits, patients may soon be able to sit in a beloved armchair–slippers on and kitty in the lap–and receive a therapy session. In a session titled “Increasing the Reach of Evidence-Based Psychotherapy with Video-to-Home Telehealth” at the 2018 American Telemedicine Association Conference & Expo (ATA18) in Chicago, experts explained how connecting with clients at home can enhance treatment, especially for U.S. service people.

The presenters included Julianna Hogan, Ph.D., a licensed psychologist and research health scientist, and Jan A. Lindsay, Ph.D., a licensed psychologist and an investigator from the South Central Mental Illness Research, Education, and Clinical Center (SC MIRECC) at the Michael E. DeBakey VA Medical Center in Houston. Co-presenters Terri Barrera, Ph.D., a clinical psychologist and research investigator at SC MIRECC and medical anthropologist and qualitative methodologist Lindsey Ann Martin, Ph.D., from the Houston Center for Innovations in Quality, Effectiveness & Safety (IQuESt) rounded out the program. The goal of the session was to educate attendees on the power of video-to-home technology (VTH) for delivering evidence-based psychotherapy to patients in rural areas and to those who might otherwise avoid receiving treatment.

The compelling presentation included three case studies of how evidence-based treatments for service-related anxiety, substance use and trauma-related disorders were adapted and tailored for delivery via VTH. The researchers all reported that using telehealth in psychotherapy increased program access, adherence and retention.

Dr. Barrera explained that most veterans prefer receiving care at home, especially those suffering from panic disorder who often struggle with agoraphobia—the extreme or irrational fear of entering open or crowded places, of leaving one’s own home, or of being in places from which escape is impeded. She added that in people traumatized by living through hurricane Harvey, for example, telemedicine has been effective in delivering care to those who became afraid to leave home. In patients treated for obsessive-compulsive disorder, eliminating the fear of contamination and constant worry about checking to see if one locked doors upon leaving the home—symptoms endemic to OCD—helps patients to focus on their care without so many intrusive thoughts.

Dr. Lindsay explained the role of telehealth delivering care to service men and women with substance use disorders who self-medicate to alleviate symptoms of anxiety disorders. Often, she explained, clinicians need to concurrently treat the mental health disorders that tend to accompany addiction, and which too often are not treated at all. The challenge, she explained, is that providers cannot check a patient’s breath for alcohol or perform on-the-spot drug testing to be sure their patients are sober. Therefore, video conference treatment works best at the beginning of treatment to engage reluctant patients but is not as effective for ongoing care.

Overall, the consensus was that, based on previous case studies and the presenters’ own experiences with patients, VTH eliminates barriers to care and improves outcomes, especially for people who have served in the military. The stigma of having mental health and substance use issues is especially prevalent in the tough-guy world of the U.S. armed forces, where such issues have long been ignored or swept under the carpet.

By receiving care via VTH, the anxieties of travelling to and sitting in clinics with fellow service people are curtailed. Stepping forward and receiving treatment in one’s home affords the privacy and quiet needed to focus on dealing with difficult symptoms. Considering that the rate of PTSD and anxiety disorders are higher in this population than the general public, VTH could open the door to providing care and recovery to the men and women who serve this country and suffer the psychological consequences.

The theme of ATA18 was “Learn. Connect. Discover.” More than 6,000 health care professionals from the clinical, academic and tech sectors of the health industry attended, along with more than 100 exhibitors from telehealth tech. Attendees learned, innovated, networked and returned to their organizations with actionable insights, long-lasting connections and an enhanced appreciation of tele-health—and how it transforms health care delivery. In addition, the meeting provided actionable insights to help shape the future of one of the most rapidly-growing healthcare sectors; influencing how future patient treatment will be delivered.

]]>http://www.reshealth.net/articles/notes-from-ata18-telehealth-aims-to-bring-psychiatric-services-home/feed/0PTSD Awareness Monthhttp://www.reshealth.net/articles/ptsd-awareness-month/
http://www.reshealth.net/articles/ptsd-awareness-month/#respondMon, 18 Jun 2018 22:06:11 +0000http://www.reshealth.net/?p=516The National Center for PTSD promotes awareness of PTSD and effective treatments throughout the year. Starting in 2010, Congress designated June 27 as PTSD Awareness Day (S. Res. 541). In 2014, the Senate designated the full month of June as National PTSD Awareness Month (S. Res. 481). After a traumatic event, most people have painful […]]]>

The National Center for PTSD promotes awareness of PTSD and effective treatments throughout the year. Starting in 2010, Congress designated June 27 as PTSD Awareness Day (S. Res. 541). In 2014, the Senate designated the full month of June as National PTSD Awareness Month (S. Res. 481).

After a traumatic event, most people have painful memories. For many people, the effects of the event fade over time. But for others, the memories, thoughts and feelings don’t go away–even months or years after the event is over. Mental health experts are not sure why some people develop PTSD and others do not. If stress reactions do not improve over time and they disrupt everyday life, it’s important to seek help to determine if PTSD is present.

The purpose of PTSD Awareness Month is to encourage everyone to raise public awareness of PTSD and effective treatments. We can all help those affected by PTSD.

Raise PTSD Awareness

You can make a difference!

“Greater understanding and awareness of PTSD will help Veterans and others recognize symptoms and seek and obtain needed care.”

Commitment to Veterans and Others

The Veterans Administration provides effective treatment for our nation’s veterans and conducts research on PTSD, including the prevention of stress disorders. The campaign supports veterans, their families, and all those who have experienced trauma to get care. Be a part of PTSD Awareness Month. For more information, go to

]]>http://www.reshealth.net/articles/ptsd-awareness-month/feed/0AT A GLANCE – BEHAVIORAL HEALTH IN THE NEWShttp://www.reshealth.net/at-a-glance/at-a-glance-behavioral-health-in-the-news/
http://www.reshealth.net/at-a-glance/at-a-glance-behavioral-health-in-the-news/#respondMon, 18 Jun 2018 22:02:51 +0000http://www.reshealth.net/?p=513Abnormalities in Visual Cortex Linked to Mental Illness According to a recent study (https://bit.ly/2I8pSV8) from Duke University, a person’s risk of mental illness broadly increases when the visual cortex has trouble communicating with brain networks responsible for focus and introspection. The researchers used brain imaging and study participant psychiatric assessments to assess the correlation between […]]]>

Abnormalities in Visual Cortex Linked to Mental Illness

According to a recent study (https://bit.ly/2I8pSV8) from Duke University, a person’s risk of mental illness broadly increases when the visual cortex has trouble communicating with brain networks responsible for focus and introspection. The researchers used brain imaging and study participant psychiatric assessments to assess the correlation between psychiatric systems and blood flow to key areas of the brain.

In people whose scores indicated a higher risk of having a mental illness, the imaging studies revealed reduced efficiency between the brain’s visual areas and certain networks important for integrating sensory information and suppressing distracting information. This reduced efficiency is common in people at risk for certain types of mental disorders.

Incidence of Involuntary Commitment for Addiction Is Growing

According to a recent analysis of state data by the Associated Press, law enforcement officials, health care providers and families are increasingly using commitment laws to force people with substance use issues into involuntary treatment (https://abcn.ws/2GZ6TLi). Approximately 35 states have laws that permit families and providers to petition judges to order individuals into treatment if the person is a threat to themselves or others.

The practice is controversial among many providers and law enforcement officers because treatment often entails painful detox without medications to mitigate withdrawal symptoms and confines patients to prison-like environments. In addition, research has shown that involuntary detox is mostly ineffective and increases the chance of patients overdosing after release from care. Civils rights groups contend that involuntary commitment may also violate U.S. civil rights laws.

Nevertheless, states are creating new legislation or acting upon extant statutes to force people with drug addiction into care. Massachusetts, for example, is considering a new law that allows providers emergency powers to remand people with addiction to detox facilities during evening and weekend hours, when judges are not available.

According to the AP’s report, many states do not track whether people with substance use issues who are forced into care are being repeatedly committed or remain sober after being released. Nevertheless, court records show Florida reported 10,000 requests for commitment in 2016 and Massachusetts had a total of 12,000 such requests in 2016 and 2017.

Kaiser Identifies New Method for Assessing Suicide Risk

A team from the Mental Health Research Network, led by Kaiser Permanente scientists, has found that combining data from electronic health records with results from standardized depression questionnaires is effective for predicting suicide risk 90 days after either mental health or primary care provider outpatient visits.

The study (https://bit.ly/2shkdGE), published in a recent issue of the American Journal of Psychiatry, included seven health systems and nearly 3 million patients age 13 or older with mental health diagnoses. The study subjects made more than 10 million specialty mental health visits and approximately another 10 million primary care visits from 2009 through June 2015. The researchers studied health system records and state death certificate data identified suicide attempts and suicide deaths over 90 days after each mental health or primary care visit.

According to the report, combining a variety of information from the past five years of people’s electronic health records and answers to questionnaires showed that new models predicted suicide risk more accurately than before. The strongest predictors for suicide included prior suicide attempts, mental health and substance use diagnoses, medical diagnoses, psychiatric medications dispensed, inpatient or emergency room care and scores on a standardized depression questionnaire.

“We demonstrated that we can use electronic health record data in combination with other tools to accurately identify people at high risk for suicide attempt or suicide death,” said lead author Gregory E. Simon, MD, MPH, a Kaiser Permanente psychiatrist in Washington and a senior investigator at Kaiser Permanente Washington Health Research Institute.

The study data showed that suicide attempts and deaths among patients whose visits were in the highest 1 percent of predicted risk were 200 times more common than among those in the bottom half of predicted risk. Patients with mental health specialty visits who had risk scores in the top 5 percent accounted for 43 percent of suicide attempts and 48 percent of suicide deaths.

Patients with primary care visits who had scores in the top 5 percent accounted for 48 percent of suicide attempts and 43 percent of suicide deaths.

Los Angeles Suing Six Pharma Companies for Opioid Epidemic

According to an article in U.S. News & World Report (https://bit.ly/2shn4zm), Los Angeles is filing a lawsuit that alleges fraudulent and negligent business practices have contributed to an “opioid addiction crisis” in that city. The targets of the suit include pharmaceutical companies Cephalon, Endo Pharmaceuticals, Insys Therapeutics, Janssen Pharmaceuticals, Mallinckrod and Purdue Pharma, and wholesale drug distributors McKesson Corp., Cardinal Health, Inc. and AmerisourceBergen Corporation.

According to an article from the Los Angeles Daily News (https://bit.ly/2IU64tp), the suit contains allegations that the companies in question misled doctors and patients about the appropriate uses, risks, safety and efficacy of pain medications while minimizing the risk of becoming addicted and exaggerating the benefits of their use. In filing the lawsuit, Los Angeles joins more than 60 other U.S. cities who have filed lawsuits against Big Pharma and drug distributors for rising rates of opioid addiction and overdose deaths.

The synthetic drug 3,4-methylenedioxy-methamphetamine (MDMA; aka, Molly, Ecstasy, X) is an illicit synthetic drug that alters mood and perception (awareness of surrounding objects and conditions). MDMA is chemically similar to both stimulants and hallucinogens, producing feelings of increased energy, pleasure, emotional warmth and distorted sensory and time perception. The drug commonly is associated with raves, dance parties and nightclubs.

Considering its negative aspects, it’s hard to imagine it as a therapeutic drug for a serious mental disorder like post-traumatic stress disorder (PTSD). However, according to a randomized controlled trial by a group of American researchers, ecstasy could be used for treating PTSD. The study, published in The Lancet Psychiatry in May 2018 (https://bit.ly/2IdVM5U), showed that Molly, in combination with psychotherapy under supervised care at certified drug abuse centers, can be an effective tool to treat PTSD symptoms in veterans and first responders.

Used illegally by millions across the United States, ecstasy can reduce inhibitions and promote feelings of euphoria among its users. When taken for longer periods of time, its use can lead to psychological and physical dependence.

Improvements in PTSD symptoms recorded

The researchers performed a randomized trial on 26 people, including armed service personnel, firefighters and a police officer at an outpatient psychiatric clinic in the United States. The participants were aged 18 years or older and were assigned to different groups of MDMA doses comprising 30 mg, 75 mg or 125 mg. Both the participants and the therapists were unaware of the strength of the dose administered. The drug was administered orally in two 8-hour sessions along with manual psychotherapy sessions. Participants received psychotherapy before the MDMA dose was administered, eight hours after the dose, as well as in the weeks that followed.

All the participants were analyzed 12 months after their last MDMA session. The researchers observed mean change in Clinician-Administered PTSD Scale (CAPS-IV) scores. According to the researchers, there was a mean change in the participants’ CAPS-IV score after the second experimental session. The participants in the 75 mg and 125 mg dose groups reported a greater improvement in the PTSD symptoms. Additionally, the participants in the 30 mg and 75 mg groups were subsequently given three 100-125 mg MDMA doses along with psychotherapy sessions. While the study participants reported a few side effects, they were minor and appeared only in the days following the MDMA dose.

MDMA should not be used to self-medicate PTSD

An individual may develop PTSD after experiencing or witnessing a traumatic life event. People with PTSD may become emotionally numb, aggressive, lose interest in things they once enjoyed or may even avoid situations that remind them of the traumatic event. Mental illnesses can affect anyone, including children, war veterans and anyone who has been through a dangerous
event or has suddenly lost a loved one.

Unfortunately, many PTSD patients self-medicate with hallucinogens like MDMA. According to the 2016 National Survey on Drug Use and Health, approximately 1.4 million people, aged 12 years and older, were current users of hallucinogens, including Molly, LSD, PCP, Salvia, ketamine, peyote, magic mushrooms, mescaline and DMT/AMT in the past year. Ecstasy procured from the street can have an unknown mix of stimulants, which may lead to brain damage, overdose or even death.

Ecstasy addiction can be cured

Addiction to MDMA can lead to health effects like nausea, blurred vision, cramped muscles, chills and sweats, among others. However, one can recover from drug dependence through specialized care at a residential addiction treatment center.

]]>http://www.reshealth.net/articles/mdma-assisted-psychotherapy-for-ptsd-symptoms-shows-promising-results/feed/0MEN’S HEALTH MONTHhttp://www.reshealth.net/articles/mens-health-month/
http://www.reshealth.net/articles/mens-health-month/#respondMon, 18 Jun 2018 21:55:50 +0000http://www.reshealth.net/?p=507Anchored by a United States Congressional health education program, Men’s Health Month is celebrated every June across the country with screenings, health fairs, media appearances and other health education and outreavch activities. The purpose of Men’s Health Month (menshealthmonth.org) is to heighten the awareness of preventable health problems and encourage early detection and treatment of […]]]>

Anchored by a United States Congressional health education program, Men’s Health Month is celebrated every June across the country with screenings, health fairs, media appearances and other health education and outreavch activities.

The purpose of Men’s Health Month (menshealthmonth.org) is to heighten the awareness of preventable health problems and encourage early detection and treatment of disease among men and boys. This month gives health care providers, public policy makers, the media, and individuals an opportunity to encourage men and boys to seek regular medical advice and early treatment for mental illnesses, disease and injury.

The centerpiece of Men’s Health Month is National Men’s Health Week, a special awareness period passed by Congress and signed into law by former President Bill Clinton on May 31, 1994 now recognized internationally. This year, National Men’s Health Week starts on June 12, and ends on Fathers’ Day, June 17.

]]>http://www.reshealth.net/articles/mens-health-month/feed/0Brain Wellness Part I: Neuroanatomy and Neurophysiology Essentialshttp://www.reshealth.net/articles/brain-wellness-part-i-neuroanatomy-and-neurophysiology-essentials/
http://www.reshealth.net/articles/brain-wellness-part-i-neuroanatomy-and-neurophysiology-essentials/#respondThu, 10 May 2018 19:42:28 +0000http://www.reshealth.net/?p=444The human brain is a remarkable organ with capacities that are still not fully understood. Only over the past few decades has it become clear that brain cells can and do regenerate and form new connections throughout a person’s lifetime. This capacity allows the brain to recover in whole or in part after injury from […]]]>

The human brain is a remarkable organ with capacities that are still not fully understood. Only over the past few decades has it become clear that brain cells can and do regenerate and form new connections throughout a person’s lifetime. This capacity allows the brain to recover in whole or in part after injury from stroke, trauma, addiction and other insults.

Working with patients who are experiencing mental illness or addiction requires an in-depth understanding of all aspects of human nature, particularly the mind. Conventional psychiatry and behavioral health science approach treatment from a neurological standpoint and target interventions based on neuroendocrine (neural and endocrine in structure or function) and cognitive science. Therefore, the purpose of this series is to review the fundamental principles of brain health, including recent developments and clinical applications for mental health care professionals.

In the Beginning

Brain development begins between the third gestational week, when embryonic stem cells begin to differentiate into neural progenitor cells – ones that differentiate into different types of brain cells before most women even realize they are pregnant. These cells follow an elaborate pattern of layering, migration, further differentiation, proliferation and regression as the brain, spinal cord and nervous system form in utero. The brain continues to grow rapidly after birth and continues to “hard wire” itself until around age 25 and even beyond.

This amazing process results in a fully formed brain and nervous system. The diagram on page 7 illustrates the major brain structures and functions.

The information processing cells that comprise the nervous system are called neurons. Neurons consist of the cell body (control center) and the processes (structures that extend from the cell body), such as dendrites (signal receivers) and axons (signal transmitters). The axon terminals are structures at the end of the axon that contain chemicals called neurotransmitters, which pass information on from neuron to neuron through chemical and electrical synapses. The following diagram details the neuron, including the organelles of the neuron body and the synapse:

Critical Connections

Connections between neurons form pathways, which result in patterns of thought and behavior over time. The pathways that neural signals follow are like hiking trails. New trails are created the first time someone hikes in a new area, which can be difficult to forge. The more the trail is used, the easier it gets to traverse. Learning and habit formation occurs in a similar fashion through the process of neural plasticity.

Neural plasticity is the capacity of nervous tissue to modify itself structurally and functionally as needed, including cell growth, cell repair, apoptosis (cell death) and the development of new circuits, which formulate new ways of thinking or behaving. The process by which these circuits form is miraculous and only recently well-defined.

Ann Graybiel of the Massachusetts Institute of Technology and her colleagues have shown that a region deep inside the brain called the striatum is key to habit formation. First, a person thinks about doing something using the prefrontal cortex, which sends electrochemical signals to the striatum, which sends the necessary signals through the basal ganglia, resulting in action. If the action is repeated, neuropathways form that loop the striatum to the sensorimotor cortex and the prefrontal cortex is bypassed. The loops, together with the memory circuits, result in automatic behavior requiring little or no thinking.

The process of habit formation is useful as it allows people to multitask, but it can make it difficult to break bad habits. One reason lifestyle changes are difficult is because it takes time to create new neuropathways, loops between the striatum and sensorimotor cortex, and requires the consistent concentration of the prefrontal cortex. But that’s not the only reason lifestyle changes are difficult. Neurotransmitters also play a powerful role in habit formation.

Brain Chemicals

The striatum is also at the core of the brain’s reward center and where neurotransmitters normally converge. The activation of neurotransmitters profoundly affects emotions, thoughts and behavior. The chart on page 8 reviews the trigger and function of neurotransmitters.

This basic diagram of the reward center of the brain illustrates the striatum in relationship to other structures and neurotransmitter pathways:

The Brain Deranged

Unhealthy lifestyle habits can cause derangements in neurotransmitters and abnormal neural pathway formation. For example, psychostimulants like cocaine or methamphetamine increase dopamine concentrations in the reward center by blocking reuptake of dopamine at the axon terminal. Accumulations of dopamine induce abnormal dopamine-dependent pathways that may persist for months even after a single exposure to a drug. To make matters worse, the mechanism that normally releases dopamine is shut off because there is so much extracellular dopamine. When the drug is metabolized, and the dopamine rush dissipates, there is little dopamine and lots of new dopamine-dependent nerve cells screaming for more drug (and they don’t take “no” for an answer). This process results in chemical dependency, in which a person’s prefrontal cortex is hijacked by the perceived physical need for more of the intoxicating substance.

As a result, healthy lifestyle habits should be encouraged at birth and be consistent. Like programming a computer, “hard wiring” the brain with healthy neuropathways results in the brain “defaulting” toward healthy behaviors later in life. But because of neural plasticity, positive change is always possible. Even people with chemical dependency can re-create healthy striatal circuits, but the need for the development of healthy lifestyle habits cannot be underemphasized in such cases.

Proper Care and Feeding of a Brain

As remarkable and resilient as the brain is, it still needs certain basic conditions to function properly. Having a brain is a lot like having a pet ‒ they are both incredible assets capable of taking their owners on amazing journeys. But like a pet, caring for a brain requires the owner to take time every day to keep it healthy. The brain needs the same things a pet does, such as oxygen, water, food, exercise, rest, stimulation and love. But if brain owners neglected their pets the same way they do their brains, the ASPCA would be knocking at their doors.

Fortunately for the brains of neglectful owners, existing brain cells can repair themselves and new neurons and synapses do develop. But the quality of daily lifestyle habits determines the quality of cell repair. From neural connections to interpersonal connections, the way we live affects our brains from the molecular level to the spiritual level. The next installment of this series will summarize how daily lifestyle habits promote or prevent brain wellness.

Dana Connolly, Ph.D., is a senior staff writer for Sovereign Health. She earned her Ph.D. in research and theory development from New York University and has decades of experience in clinical care, medical research and health education. For more information and other inquiries about this article, contact the author at news@sovhealth.com, visit us at SovHealth.com, Facebook and LinkedIn, or follow us on Twitter.

]]>http://www.reshealth.net/articles/brain-wellness-part-i-neuroanatomy-and-neurophysiology-essentials/feed/0Is Addiction A Mental Illness?http://www.reshealth.net/articles/is-addiction-a-mental-illness/
http://www.reshealth.net/articles/is-addiction-a-mental-illness/#respondThu, 10 May 2018 19:41:52 +0000http://www.reshealth.net/?p=414Addiction is a brain disease, but it’s not typically treated as one. Why? What makes addiction different from a mental illness? Is addiction different from a mental illness in the first place? To address this question, it may help to review some of the similarities and differences between addiction and mental illnesses. Similarities Between Mental […]]]>

Addiction is a brain disease, but it’s not typically treated as one. Why? What makes addiction different from a mental illness? Is addiction different from a mental illness in the first place?
To address this question, it may help to review some of the similarities and differences between addiction and mental illnesses.

Similarities Between Mental Illness and Addiction

Substance use and mental disorders share many traits. Examples include the following:

1. Both addiction and mental illness have genetic links.
2. People with mental illness are more likely to have family members with mental illness, and people with substance addiction are more likely to have family members with substance use issues. Researchers suspect that people with drug addiction have genetic variants that impede dopamine receptors from functioning correctly (https://bit.ly/2FdJ1Tm).
3. Both addiction and mental illness are biological.
4. Addiction, like mental illness, is a disease and not a moral failing. People who are coping with addiction have brain structures that look and behave differently than people without addiction
(https://bit.ly/2vJ8B39).
The same is true of people with mental illness
(https://bit.ly/2ANfD4x).
5. Both addiction and mental illness can have environmental triggers.

Not everyone who is genetically predisposed to mental illness will develop a mental disorder, just like not everyone who is genetically predisposed to addiction will develop a substance use disorder. This is because both mental illness and addiction can have environmental triggers. For instance, people who are predisposed to addiction may not develop one until they receive prescription opioids, just as people who are predisposed to PTSD may never develop symptoms if they don’t experience a traumatic event.

Preventative Care Can Make a Difference

Although mental illness and addiction are both diseases, they can be prevented (or their onset can be delayed) by maintaining good health habits. People who are at risk for mental illness can practice good sleep habits, avoid stress, exercise regularly and eat healthfully, all of which have been found to positively influence mental health. People who are predisposed to addiction can maintain similar habits and/or abstain from drugs and alcohol to reduce the likelihood of developing a disorder.

Mental illness and addiction often require lifelong treatment. People with schizophrenia may need to take medication and attend therapy for the rest of their lives, whereas those afflicted with alcoholism may need to consistently attend peer support group meetingss. It’s possible to relapse with mental illness just as it’s possible to relapse with substance addiction. For instance, people with for treated bipolar disorder may find their symptoms grow worse during a stressful period. They may require new medication or even hospitalization. The symptoms associated with addiction can also wax or wane depending on life circumstances.
In addition to these similarities, most doctors believe that addiction is a mental illness. Substance use disorder
(https://bit.ly/2hJ3GU6) are included in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), which contains extensive information on every mental disorder.

Differences Between Mental Illness and Addiction

There are very few differences between mental illness and addiction. The main difference is that addiction involves mind-altering substances, many of which are illegal or morally frowned upon. For this reason, people with substance use disorders experience a distinct stigma and are often treated as though they are corrupt or fundamentally bad. (Mental illness, it should be noted, has its own serious stigma.)

The stigma associated with drug addiction is often reflected in the vocabulary used to describe it. For instance, people who are addicted to drugs are said to “abuse” them, implying that they are actively harming another entity when they are only harming themselves. (Clinicians prefer the term drug “misuse”).
People who are addicted to substances are thought to have to “hit rock bottom” before being motivated to seek treatment, whereas people with mental illness are urged to seek treatment as soon as possible, an ultimately healthier course of action. The sooner a person with drug misuse seeks treatment, the more successful the outcome can be.

Why Treat Addiction Like a Mental Illness?

As mentioned, addiction is included in the DSM-5, the official guidebook on mental health. Clinicians and patients can both benefit from interventions that are typically reserved for mental health disorders, such as therapy and brain wellness practices.
Addiction is a brain illness. It’s vital that health care specialists treat it as such.